E4664. Imaging Evaluation for the Staging of Laryngeal Squamous Cell Carcinoma: What the Otolaryngologist Wants to Know
Authors
Sarina Masso Maldonado;
San Antonio Uniformed Services Health Education Consortium
Michael Povlow;
General Leonard Wood Army Community Hospital
Jason Kim;
University of California San Francisco
Douglas Mack;
San Antonio Uniformed Services Health Education Consortium
Sunthosh Madireddi;
San Antonio Uniformed Services Health Education Consortium
Francis Cloran;
San Antonio Uniformed Services Health Education Consortium
Background
Radiological evaluation of laryngeal squamous cell carcinoma (LSCC) plays a pivotal role in accurate tumor staging and treatment planning. Laryngeal cancer incidence has increased 12% over the past 3 decades, and LSCC makes up nearly 98% of all laryngeal cancers. Given the high clinical burden this oncologic entity poses, radiologists should be familiar with the laryngeal anatomy and subsites, common routes of LSCC spread, and how to stage the disease. After endoscopy, cross-sectional imaging is critical to determine submucosal invasion of surrounding structures, extent of tumor burden, nodal and systemic metastasis, and presence of synchronous tumors. All of these factors are used to determine the appropriate staging, which ultimately guides management of the disease.
Educational Goals / Teaching Points
This exhibit focuses on reviewing pertinent head and neck anatomy for staging LSCC; discussing the role of imaging for the multidisciplinary management of LSCC; considering the common pitfalls and ways to avoid them when reporting and staging LSCC; and demonstrating multimodality examples of the imaging findings of LSCC including CT, MRI, and PET.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The larynx has a unique anatomy consisting of three divisions with subsites: supraglottic, glottic, and subglottic. Each of the subsites has a different disease presentation, pattern of disease spread, treatment, and prognosis. Additionally, each subsite has a distinctive primary tumor T-staging system that varies by location and extension into specific anatomic landmarks, which can make staging a challenging but important task for the radiologist. With this complex anatomy and intricate staging system come pitfalls that radiologists must try to avoid using certain techniques. A multidisciplinary and often multimodality approach including CT, MRI, and/or PET/CT, is needed to achieve the most accurate staging system for otolaryngologists. We will provide a series of cases demonstrating staging examples and how to avoid common pitfalls.
Conclusion
LSCC is the most common oncologic entity of the larynx, with an intricate pattern of disease spread and staging system. Having a detailed anatomic understanding of the larynx and common methods of disease spread, as well as using different imaging techniques and a multidisciplinary approach, aids radiologists in providing the most accurate staging and treatment plan.
